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RCGP drops gender dysphoria course due to ‘unrealistic expectations’ on GPs



The RCGP has dropped an online course on gender dysphoria following GP concerns that they are being expected to prescribe outside of their clinical competence.

The e-learning course, launched in 2015 in partnership with the charity Gender Identity Research & Education Society (GIRES), was developed in response to the ‘lack of high-quality clinical guidance’, the RCGP said.

However, the RCGP decided to remove the course from its website in December as it could create ‘unrealistic expectations for patients regarding the role of the GP in initiating treatment’. 

GP leaders said they should not have to ‘bear the brunt of poor access to specialist gender reassignment’ and argued they do not have the training to prescribe some of the treatments mentioned.

In 2017, NHS England published a consultation on gender identity services, asking for views on GPs’ involvement in prescribing hormone therapy.

This followed a row between the GP Committee and GMC over GPs’ concerns that they were being forced to prescribe to gender dysphoria patients without the necessary expertise. The GPC responded by advising GPs to ignore GMC guidance on the matter.

The RCGP gender dysphoria course provided guidance to GPs on how to prescribe and monitor the medication recommended by the specialist clinicians in the gender identity clinics.

Prior to the removal of the course, the RCGP made a series of changes to lessen the burden on GPs, which included the insertion of additional wording and the deletion of references.

But in a statement, GIRES – which paid the RCGP £7,837 to run the course – said the changes were made without authorisation, and undermined ‘the responsibility of GPs to precribe and monitor the medication recommended by the specialist clinicians in the gender identity clinics’.

‘Refusal of primary care support is a major detriment and GIRES could not agree to changes in a resource that was meant to help GPs to support transgender people with confidence, when the changes made are in direct contravention of NHS and GMC guidelines, and give GPs excuses to deny access to healthcare for transgender people,’ the statement said.

RCGP honorary secretary Dr Jonathan Leach said: ‘GPs should not have to bear the brunt of poor access to specialist gender reassignment services by being put in a position where they are being asked to prescribe treatment that they are not trained to prescribe or monitor safely without expert support’. 

‘In the vast majority of cases, trans patients will present to the GP with the same conditions that cisgender patients do. But new presentations of gender reassignment are exceptional in general practice – it is a specialist area of medicine, and treatment should be initiated in specialist care,’ he added.

Pulse reported last year about the lack of progress on an awaited transgender service in Wales, expected to be in place by the end of March 2018 but later set to open in October.

The RCGP said it is currently funding and developing a new e-learning course for GPs on gender variance, which is set to be launched later this year.